BackgroundSafety and effectiveness of efficacious antiretroviral (ARV) regimens beyond
single-dose nevirapine (sdNVP) for prevention of mother-to-child
transmission (PMTCT) have been demonstrated in well-controlled clinical
studies or in secondary- and tertiary-level facilities in developing
countries. This paper reports on implementation of and factors associated
with efficacious ARV regimens among HIV-positive pregnant women attending
antenatal clinics in primary health centers (PHCs) in Zambia.MethodsBlood sample taken for CD4 cell count, availability of CD4 count results,
type of ARV prophylaxis for mothers, and additional PMTCT service data were
collected for HIV-positive pregnant women and newborns who attended 60 PHCs
between April 2007 and March 2008.ResultsOf 14,815 HIV-positive pregnant women registered in the 60 PHCs, 2,528
(17.1%) had their CD4 cells counted; of those, 1,680 (66.5%) had CD4 count
results available at PHCs; of those, 796 (47.4%) had CD4 count ≤ 350
cells/mm3 and thus were eligible for combination
antiretroviral treatment (cART); and of those, 581 (73.0%) were initiated on
cART. The proportion of HIV-positive pregnant women whose blood sample was
collected for CD4 cell count was positively associated with (1) blood-draw
for CD4 count occurring on the same day as determination of HIV-positive
status; (2) CD4 results sent back to the health facilities within seven
days; (3) facilities without providers trained to offer ART; and
(4) urban location of PHC. Initiation of cART among HIV-positive pregnant
women was associated with the PHC's capacity to provide care and
antiretroviral treatment services. Overall, of the 14,815 HIV-positive
pregnant women registered, 10,015 were initiated on any type of ARV regimen:
581 on cART, 3,041 on short course double ARV regimen, and 6,393 on
sdNVP.ConclusionEfficacious ARV regimens beyond sdNVP can be implemented in
resource-constrained PHCs. The majority (73.0%) of women identified eligible
for ART were initiated on cART; however, a minority (11.3%) of HIV-positive
pregnant women were assessed for CD4 count and had their test results
available. Factors associated with implementation of more efficacious ARV
regimens include timing of blood-draw for CD4 count and capacity to initiate
cART onsite where PMTCT services were being offered.
Tri-directional screening was feasible for detecting and managing previously undiagnosed TB and DM. More work is needed to better understand the interaction between HIV and DM.
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